Provider Demographics
NPI:1689343550
Name:SIGNATURE WOMEN'S HEALTHCARE OF GEORGIA, LLC
Entity Type:Organization
Organization Name:SIGNATURE WOMEN'S HEALTHCARE OF GEORGIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:ZANE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-303-8035
Mailing Address - Street 1:5780 PEACHTREE DUNWOODY RD STE 300
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1513
Mailing Address - Country:US
Mailing Address - Phone:404-303-8035
Mailing Address - Fax:404-303-1325
Practice Address - Street 1:5900 HILLANDALE DR STE 245
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30058-6801
Practice Address - Country:US
Practice Address - Phone:770-323-9300
Practice Address - Fax:678-395-2023
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ATLANTA WOMEN'S HEALTH GROUP, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-09-13
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA300034164AMedicaid